Medi-systemic disease Flashcards
(25 cards)
True or false:
DM is an independent risk factor for CAD
True
True or false:
CAD is the most common cause of death in adults with DM
True
Treatment of Type II DM
- treat them as though they’ve had an MI
1. Aspirin
2. Control blood sugars (A1c <7)
3. Control HTN (ACEI or ARB)
4. Control lipids (statins, LDL <70)
Cardiometabolic syndrome
Must have 3/5
- HTN
- High LDL
- Low HDL
- Glucose intolerance
- Large waist circumference
Obesity causes eccentric cardiac hypertrophy with ventricular dilation. This leads to:
1.
2.
3.
- Increased circulating blood volume
- Increased CO
- Increased LV filling pressure
What are some functions of thyroid hormone?
- metabolism
- oxygen consumption
- inotropic and chronotropic effects
- increases synthesis of myosin and Na-K ATPase
- increases # of beta adrenergic receptors
Effects of hyperthyroidism on CV system
- palpitations (forceful contractions, sinus tach, a fib)
- systolic and pulmonary HTN
- fatigue
- HF and angina
- hyper dynamic precordium
- widened pulse pressure
- LV hypertrophy
- 3rd heart sound
- increased 1st heart sound
Treatment of hyperthyroidism
TREAT SYMPTOMS FIRST
- beta blockers for symptoms (propranolol or atenolol)
- anticoagulants for pts in a fib
- diuretics or digitalis for HF
- radioactive iodine or anti-thyroid (PTU or mithimazol) to treat hyperthyroidism
Effects of hyperthyroidism on CV system
- decreased CO (bradycardia, decreased SV)
- HTN (increased systemic vascular resistance)
- decreased exercise tolerance (dyspnea on exertion)
- fatigue
- HF and angina
- pericardial effusions
- hypercholesterolemia
- hyperhomocysteinemia
- lower extremity edema
Treatment of hypothyroidism
T4 replacement
Caution of iatrogenic hyperthyroidism
Classic triad of pheochromocytoma (too much NE and Epi)
*other symptoms?
Sweating
Tachycardia
Episodic headache
*paroxysmal HTN, orthostatic hypotension (decreased plasma volume), dilated cardiomyopathy (toxic effect of catecholamines, secondary erythocytosis)
True or false:
Hypothyroidism and hyperthyroidism can have the exact same symptoms
True
Symptoms of Acromegaly
- HTN (suppression of RAS, increase in total body Na and plasma volume)
- LV hypertrophy
- Cardiomyopathy (diastolic dysfunction, arrhythmias)
- Increased prevalence of valvular heart disease
RA increases risks for what?
CAD
HF
Pericarditis
Myocarditis
Cardiac disease is very common in Systemic Lupus Erytematosus
Pericardial
Myocardial
CAD
Valvular heart disease
SLE
Valvular disease:
- Systolic murmurs (structural, anemia, fever, tachycardia)
- mitral valve is most commonly effected (prolapse, vegetations, regurgitation, stenosis)
- Libman-Sacks endocarditis (verrucous endocarditis)
Libman-Sacks endocarditis is most common of ____ valves
Aortic and mitral valves near the edge
Sub sternal chest pain
Most common cause of symptomatic cardiac involvement in SLE
Treat with NSAIDs and steroids
Pericarditis
Rare May cause conduction abnormalities Suspect if there is resting tachycardia with unexplained cardiomegaly Systolic and/or diastolic dysfunction May present with HF symptoms
SLE myocarditis
First degree heart block, often transient
Higher degrees of blocks and arrhythmias are uncommon in adults congenital heart block as part of neonatal lupus
SLE Conduction abnormalities
Antibodies tested in pregnant women with lupus (because they can cause congenital heart blocks)
Anti-Ro
Anti-La
In severe protein calorie malnutrition what happens?
Weakened, hypokinetic heart muscle Edema from decreased oncotic pressure AIDS Anorexia Nervosa HF patients
What happens with thiamine deficiency?
Wet Beriberi High-out failure (edema everywhere) Tachycardia Elevated ventricular filling pressures Rapid response to thiamine replacement
What happens in vitamin B6, B12, and Folate deficiencies?
Hyperhomocyteinemia
Increased atherosclerotic risk
*replacement doesn’t decrease risk
